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Catheter Ablation of Atrial Fibrillation: Advances and Challenges
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Catheter Ablation of Atrial Fibrillation: Advances and Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 September 2025) | Viewed by 10990

Special Issue Editors

Dr. Nicholas Yick Loong Tan

E-Mail Website
Guest Editor
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
Interests: atrial fibrillation; catheter ablation; arrhythmias; cardiac electrophysiology; heart failure; ventricular tachycardia; ventricular fibrillation; sudden cardiac death; cardiac devices
Dr. Christopher V. DeSimone

E-Mail Website
Guest Editor
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
Interests: atrial fibrillation; atrial flutter; atrial tachycardia; arrhythmias; sudden cardiac death; cardiac device; interventional cardiology

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) is the most common heart rhythm disorder in the United States and many other countries across the globe. Numerous groundbreaking technologies and techniques in AF catheter ablation have been developed over the years, allowing it to mature as a durable option for rhythm control. Despite these advances, many gaps regarding the pathophysiology and mechanisms that initiate and sustain AF remain; in turn, these continue to underpin challenges that we encounter in terms of improving outcomes and minimizing complications.

In this Special Issue, we summarize the tremendous progress made in terms of AF catheter ablation and provide a preview of emerging therapies/modalities that are on the horizon. In addition, we highlight the challenges we currently face and opportunities for future growth. Researchers in the field of clinical arrhythmology and electrophysiology are encouraged to submit their findings as original articles or reviews to this Special Issue. Submissions focusing on innovative approaches, novel technologies, and outcomes of clinical studies are particularly encouraged.

Dr. Nicholas Yick Loong Tan
Dr. Christopher V. DeSimone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • atrial fibrillation
  • catheter ablation
  • pulmonary vein isolation
  • cardiac electrophysiology
  • cardiac resynchronization therapy
  • pulsed field ablation
  • hybrid ablation
  • non-pulmonary vein triggers

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Published Papers (4 papers)

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Research

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15 pages, 636 KB  
Article
Predictive Value of Epicardial Adipose Tissue Parameters Measured by Cardiac Computed Tomography for Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation
by Karol Momot, Michal Pruc, Dariusz Rodkiewicz, Edward Koźluk, Kamil Krauz, Agnieszka Piątkowska, Zuzanna Zalewska, Małgorzata Buksińska-Lisik, Lukasz Szarpak and Artur Mamcarz
J. Clin. Med. 2025, 14(19), 6963; https://doi.org/10.3390/jcm14196963 - 1 Oct 2025
Cited by 2 | Viewed by 1425
Abstract
Background: Despite advances in ablation strategies, a substantial proportion of patients with atrial fibrillation (AF) experience arrhythmia recurrence, highlighting the need for improved preprocedural risk stratification. One of the emerging factors associated with arrhythmogenic remodeling is epicardial adipose tissue (EAT), particularly in the [...] Read more.
Background: Despite advances in ablation strategies, a substantial proportion of patients with atrial fibrillation (AF) experience arrhythmia recurrence, highlighting the need for improved preprocedural risk stratification. One of the emerging factors associated with arrhythmogenic remodeling is epicardial adipose tissue (EAT), particularly in the proximity of the left atrium (LA), due to its metabolic and inflammatory activity. Methods: This study investigated whether preprocedural assessment of EAT parameters on computed tomography (CT), including volume, mean attenuation, and attenuation dispersion, could predict AF recurrence following ablation. Seventy patients with AF underwent either pulsed field or cryoballoon ablation and were followed for 18 months. Results: Recurrence of AF occurred in 26 (37.1%) patients. Both higher LA-EAT attenuation (OR 1.09; 95% CI: 1.02–1.17) and greater total-EAT volume (OR 2.41; 95% CI: 1.16–4.99) were independently associated with arrhythmia recurrence. Subgroup analysis revealed that LA-EAT volume was highly predictive of recurrence in patients with persistent AF (AUC = 0.91), whereas LA-EAT attenuation demonstrated greater prognostic value in those with paroxysmal AF (AUC = 0.80). Conclusions: These findings suggest that quantitative evaluation of EAT using routine cardiac CT may enhance risk stratification before ablation. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: Advances and Challenges)
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9 pages, 4146 KB  
Article
Hyperenhancement of LA Wall by Three-Dimensional High-Resolution Late Gadolinium-Enhanced MRI and Recurrence of AF After Catheter Ablation
by Minako Kagimoto, Shingo Kato, Ryouya Takizawa, Sho Kodama, Keisuke Suzurikawa, Mai Azuma, Naoki Nakayama, Kohei Iguchi, Kazuki Fukui, Masanori Ito, Tae Iwasawa, Tabito Kino and Daisuke Utsunomiya
J. Clin. Med. 2024, 13(23), 7357; https://doi.org/10.3390/jcm13237357 - 3 Dec 2024
Cited by 1 | Viewed by 1780
Abstract
Background/Objectives: This study investigated the relationship between LA (LA) enhancement on three-dimensional (3D) late gadolinium enhancement (LGE) MRI and recurrence after catheter ablation in patients with AF (AF). Methods: A total of one hundred patients with AF (mean age: 68 ± [...] Read more.
Background/Objectives: This study investigated the relationship between LA (LA) enhancement on three-dimensional (3D) late gadolinium enhancement (LGE) MRI and recurrence after catheter ablation in patients with AF (AF). Methods: A total of one hundred patients with AF (mean age: 68 ± 9 years, 50% with paroxysmal AF) were included in this study. Each patient underwent a high-resolution 3D LGE MRI prior to catheter ablation, allowing for detailed imaging of the LA wall. Quantitative analysis of the enhancement was performed using dedicated software designed for volumetric measurements of LA LGE. Recurrence of AF was monitored over a 90-day period following the ablation procedure. The primary outcome was the correlation between the volume of LGE in the LA and the recurrence of AF. Results: Multivariate analysis confirmed that the volume of LA LGE, defined as the volume exceeding 1SD above the mean signal intensity of the LA, was an independent predictor of recurrence [hazard ratio: 1.16 (95%CI: 1.04–1.29, p = 0.0057)]. The area under the curve for recurrence prediction using 3D LGE MRI was 0.74 (95%CI: 0.63–0.86), with an optimal threshold of 11.72 mL, providing a sensitivity of 55% (95%CI: 32–77%) and a specificity of 86% (95%CI: 77–93%). Conclusions: LA enhancement assessed by high-resolution LGE MRI may serve as a valuable imaging marker for predicting the recurrence in patients with AF following catheter ablation. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: Advances and Challenges)
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Review

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14 pages, 3102 KB  
Review
Pulsed Field Ablation for Atrial Fibrillation: Contemporary Clinical Evidence and Real-World Experience in Redo Ablation
by Ioanna Koniari, Eleni Artopoulou, Scott Gall, Gavin S. Chu, Rafail Koros, Maria Bozika, Kassiani-Maria Nastouli, Georgios Leventopoulos, Shajil Chalil and Aruna Arujuna
J. Clin. Med. 2026, 15(4), 1647; https://doi.org/10.3390/jcm15041647 - 22 Feb 2026
Viewed by 1872
Abstract
Atrial fibrillation (AF) is the most common prevalent sustained arrhythmia and is associated with stroke, heart failure, and impaired health-related quality of life. Due to the complexity of the initiation and the persistence of AF, the pulmonary vein isolation (PVI) using thermal or [...] Read more.
Atrial fibrillation (AF) is the most common prevalent sustained arrhythmia and is associated with stroke, heart failure, and impaired health-related quality of life. Due to the complexity of the initiation and the persistence of AF, the pulmonary vein isolation (PVI) using thermal or laser energy is the most commonly applied ablation strategy. However, these thermal ablation modalities have several limitations, including a substantial risk of AF recurrence and collateral damage to tissues adjacent to the heart. Pulsed field ablation (PFA) is a novel non-thermal ablation technique in which high-voltage electric fields deliver short pulses, selectively affecting cardiomyocyte cell membranes. PFA has the potential to create myocardial lesions with minimal harm to non-cardiac tissues. Clinical studies have evaluated the safety and efficacy of PFA, examining its ability to prevent AF recurrence and its impact on surrounding structures, often in comparison with conventional PVI approaches. In this review, PFA clinical studies are discussed as well as our experience with the PFA use for redo atrial fibrillation ablation cases. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: Advances and Challenges)
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13 pages, 264 KB  
Review
Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure: Focus on the Latest Clinical Evidence
by Andrea Demarchi, Matteo Casula, Ginevra Annoni, Marco Foti and Roberto Rordorf
J. Clin. Med. 2024, 13(17), 5138; https://doi.org/10.3390/jcm13175138 - 29 Aug 2024
Cited by 1 | Viewed by 5097
Abstract
Atrial fibrillation and heart failure are two common cardiovascular conditions that frequently coexist, and it has been widely demonstrated that in patients with chronic heart failure, atrial fibrillation is associated with a significant increase in the risk of all-cause death and all-cause hospitalization. [...] Read more.
Atrial fibrillation and heart failure are two common cardiovascular conditions that frequently coexist, and it has been widely demonstrated that in patients with chronic heart failure, atrial fibrillation is associated with a significant increase in the risk of all-cause death and all-cause hospitalization. Nevertheless, there is no unanimous consensus in the literature on how to approach this category of patients and which therapeutic strategy (rhythm control or frequency control) is the most favorable in terms of prognosis; moreover, there is still a lack of data comparing the different ablative techniques of atrial fibrillation in terms of efficacy, and many of the current trials do not consider current ablative techniques such as high-power short-duration ablation index protocol for radiofrequency pulmonary vein isolation. Eventually, while several RCTs have widely proved that in patients with heart failure with reduced ejection fraction, ablation of atrial fibrillation is superior to medical therapy alone, there is no consensus regarding those with preserved ejection fraction. For these reasons, in this review, we aim to summarize the main updated evidence guiding clinical decision in this complex scenario, with a special focus on the most recent trials and the latest meta-analyses that examined the role of catheter ablation (CA) in rhythm control in patients with AF and HF. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: Advances and Challenges)
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